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Form Approved OMB No. 0920-0666 Exp. Date 12/31/2017 www. cdc.gov/nhsn Ventilator-Associated Event VAE Page 1 of 4 required for saving required for completion Facility ID Patient ID Secondary ID Patient Name Last Gender F M Other Ethnicity Specify Event Type VAE Post-procedure VAE Yes No NHSN Procedure Code MDRO Infection Surveillance Event Social Security Medicare First Date of Birth Race Specify Date of Event Date of Procedure ICD-9-CM Procedur...
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What is cdc 57112 form?
The CDC 57112 form is a document used by the Centers for Disease Control and Prevention (CDC) to collect information about certain diseases or conditions. It is used for surveillance and monitoring purposes.
Who is required to file cdc 57112 form?
Healthcare providers, laboratories, and other entities that are responsible for diagnosing or treating patients with the specified diseases or conditions are required to file the CDC 57112 form.
How to fill out cdc 57112 form?
To fill out the CDC 57112 form, you need to provide information such as patient demographics, diagnostic details, and relevant medical history. The specific instructions for filling out the form can be found on the CDC's website or accompanying documentation.
What is the purpose of cdc 57112 form?
The purpose of the CDC 57112 form is to gather data on specific diseases or conditions in order to monitor their prevalence, understand patterns and trends, and facilitate public health interventions if necessary.
What information must be reported on cdc 57112 form?
The CDC 57112 form requires information such as patient demographics (e.g., age, gender), diagnostic details (e.g., disease or condition being reported), relevant medical history, and any other specified data points as required by the CDC.
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